Every finding on record at Spring Hope Hospice, Inc.

Upon patient record review, 1 of 5 (Patient #1) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: The record shows a treatment order for oxygen at 2LPM via nasal cannula PRN for SOB written on 04/30/2024. No evidence that oxygen was ever placed on the active medication profile. COS

Upon patient record review, 1 of 5 (Patient #2) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 2: Patient admitted with secondary dx of depression and pain. Currently taking Cymbalta for depression/pain. No evidence that interventions and goals for depression included in the current plan of care. COS